title: Real-time continuous glucose monitoring significantly reduces severe hypoglycemia in hypoglycemia-unaware patients with type 1 diabetes.
abstract: OBJECTIVE
  To evaluate the effect of continuous glucose monitoring (CGM) on the frequency of severe hypoglycemia (SH) in patients with established hypoglycemia unawareness.
  
  
  METHODS
  We conducted a retrospective audit of 35 patients with type 1 diabetes and problematic hypoglycemia unawareness, despite optimized medical therapy (continuous subcutaneous insulin infusion/multiple daily insulin injections), who used CGM for >1 year.
  
  
  RESULTS
  Over a 1-year follow-up period, the median rates of SH were reduced from 4.0 (interquartile range [IQR] 0.75-7.25) episodes/patient-year to 0.0 (0.0-1.25) episodes/patient-year (P < 0.001), and the mean (±SD) rates were reduced from 8.1 ± 13 to 0.6 ± 1.2 episodes/year (P = 0.005). HbA1c was reduced from 8.1 ± 1.2% to 7.6 ± 1.0% over the year (P = 0.005). The mean Gold score, measured in 19 patients, did not change: 5.1 ± 1.5 vs. 5.2 ± 1.9 (P = 0.67).
  
  
  CONCLUSIONS
  In a specialist experienced insulin pump center, in carefully selected patients, CGM reduced SH while improving HbA1c but failed to restore hypoglycemia awareness.
authors.affiliation: Corresponding author: Pratik Choudhary, pratik.choudhary@kcl.ac.uk.
authors.forename: Pratik
authors.initials: P
authors.lastname: Choudhary
authors.forename: Sharmin
authors.initials: S
authors.lastname: Ramasamy
authors.forename: Louisa
authors.initials: L
authors.lastname: Green
authors.forename: Geraldine
authors.initials: G
authors.lastname: Gallen
authors.forename: Siobhan
authors.initials: S
authors.lastname: Pender
authors.forename: Anna
authors.initials: A
authors.lastname: Brackenridge
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Amiel
authors.forename: John C
authors.initials: JC
authors.lastname: Pickup
mesh_terms: D000328:Adult; D001364:Awareness; D054869:Clinical Audit; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D015309:Glucose Clamp Technique; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control* / Q000523:psychology; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D055104:Infusions, Subcutaneous; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007332:Insulin Infusion Systems; D008297:Male; D011379:Prognosis; D012107:Research Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin